Section 1200-07-04-.01 - DEFINITIONS(1) "Ambulatory Surgical Treatment Center" shall have the same definition as contained in T.C.A. § 68-11-201.(2) "ASTC" is the acronym for ambulatory surgical treatment center.(3) "Claim" shall mean a charge or bill for services rendered, billed to the patient, to another private individual, or to a third party payer, public or private.(4) "Claims Data" shall mean all data elements collected for all patients for whom an ASTC or ODC provides services that are entered on any claim form prepared by the ASTC or ODC and shall always include those required data elements identified in the subparagraphs listed in rule 1200-07-04-.04, paragraphs (1) and (2).(5) "CMS-1500" shall mean the claim form "Centers for Medicare & Medicaid Services 1500" or its successor form.(6) "Commissioner" shall mean the commissioner of the Tennessee Department of Health.(7) "Data Element" shall mean any individual piece of information collected from a patient by an ASTC or ODC during the process of providing services to that patient for which the ASTC or ODC will file a claim.(8) "Department" shall mean the Tennessee Department of Health.(9) "Error" shall mean data that are incomplete or inconsistent with the specifications in the ASTC Data System Procedural Manual, the ODC Data System Procedural Manual, or these rules.(10) "Final Joint Annual Report" shall mean the most recent Joint Annual Report filed by an ASTC or ODC where the data contained in the report have been edited, queried, and updated when appropriate, by the Department.(11) "JAR" is the acronym for Joint Annual Report.(12) "ODC" is the acronym for outpatient diagnostic center.(13) "Outpatient Diagnostic Center" shall have the same definition as contained in T.C.A. § 68-11-201.(14) "Personal Identifiers" shall be defined to include all the identifiers contained in 45 C.F.R. § 164.514 (b) or (e).(15) "Processed Data" shall mean data that have been analyzed by the Department or the Department's designated data vendor(s) and errors, inconsistencies, and/or incomplete elements in the data set, if any, have been identified.(16) "Public" shall mean anyone other than the Tennessee Department of Health, its vendors, and its contracted agencies.(17) "Record Level Data" shall mean a set of data that is specific to individual patient claims.(18) "State" shall mean the government of the State of Tennessee including all its agencies.(19) "UB-04" shall mean the CMS Form 1450, [a.k.a. "the Uniform Hospital Billing Form"], or its successor forms as established by the National Uniform Billing Committee and the State Uniform Billing Implementation Committee.(20) "Vendor" shall mean a third party entity, approved by the Department, through whom an ASTC or ODC submits its claims data for the purpose of compilation and editing according to these rules and the instructions of the Department.(21) "Verified Data" shall mean data that have been processed by the Department after the ASTCs or ODCs have had the opportunity to suggest corrections and/or deletions, and all appropriate revisions have been made to the data and approved by the Department.Tenn. Comp. R. & Regs. 1200-07-04-.01
Original rule filed January 27, 2005; effective April 12, 2005. Repeal and new rule filed January 29, 2013; effective June 30, 2013.Authority: T.C.A. §§ 68-1-103 and 68-1-119.